COPD/Pneumonia Care Plan

  1. 0 Struggling to find a good care plan for a patient with COPD and Pneumonia.

    Thoughts...Impaired Gas Exchange....but unsure of related to?

    It's near the end of the semester. I just need some guidance. Looking for 2 diagnosis/care plans for this patient.
  2. Visit  swimmin4fun247 profile page

    About swimmin4fun247

    Joined Apr '12; Posts: 3; Likes: 1.

    17 Comments so far...

  3. Visit  FORTHELOVEOF!!!! profile page
    1
    Impaired gas exchange r/t decreased functional lung tissue
    Activity intolerance r/t imbalance between oxygen supply and demand
    Anxiety r/t breathlessness, change in health status
    Ineffective airway clearance r/t bronchoconstriction, increased mucus, ineffective cough, or infection.

    Hope this helps
    Esme12 likes this.
  4. Visit  swimmin4fun247 profile page
    1
    I didn't even think about anxiety. Thank you very much.
    FORTHELOVEOF!!!! likes this.
  5. Visit  Floridatrail2006 profile page
    1
    First, we need more data. We need more information in order to effectively formulate a care plan. What is the patient's response to COPD and Pneumonia? Is the patient admitted for pneumonia and has a history of COPD? What are your assessment findings including VS, physical, lab values, Chest Xray, etc?
    Esme12 likes this.
  6. Visit  GrnTea profile page
    0
    please, please, please-- you do not write a nursing care plan by writing down the diagnoses first. first you do your patient assessment so you have enough information to make the diagnoses, and then you write the care plan.

    you sound as if you decided (or were assigned) to "write a care plan for copd." if this was an assignment, it's illustrative of why students have such a hard time learning the nursing process-- they pick some sexy-sounding nursing diagnoses and then try to cram the facts into them to make them fit. faculty should make it clear that this is not how the nursing process works, and give the students enough pretend data to work from.

    however, it's possible that i'm wrong, and you already took care of a patient with copd, and now you have to write your care plan. better.

    so. what data do you have, and where does it lead you? what defining characteristics for each nursing diagnosis have you identified in the patient?

    when you go to your nanda-i 2012-2014 (which every student should have), and noodle around in the domains (health promotion, nutrition, elimination and exchange, activity and rest, perception/cognition, self-perception, role, sexuality, coping and stress, life principles, safety, comfort, and growth and development) what do you see that might apply to your patient?

    when you flip open the book to that page, say, comfort, and find "impaired comfort," you will find 18 (in this example) defining characteristics of the nursing diagnosis impaired comfort, and 7 (in this example) factors to which they could be related. if your patient exhibited any of these characteristics, you can diagnose "impaired comfort," and set about determining ways you can make him more comfortable by addressing the defining characteristics that are making him uncomfortable. that is the nursing process-- collect assessment data, determine a diagnosis from them, prescribe nursing remedies, state how you'll measure your remedies' effectiveness, evaluate how they worked, revise as needed.

    we are not (at least some of us are not
    ) going to write your care plan for you. but this is how you should approach it and do it. do not be frightened or freaked out because you can't do it off the top of your head using "common sense," because if common sense were enough we wouldn't need to be teaching you nursing in nursing school. this, the nursing process, is what you are here to learn, because this is what you will be doing when you graduate and go into practice. learn it.
  7. Visit  Floridatrail2006 profile page
    0
    Quote from grntea
    please, please, please-- you do not write a nursing care plan by writing down the diagnoses first. first you do your patient assessment so you have enough information to make the diagnoses, and then you write the care plan.

    you sound as if you decided (or were assigned) to "write a care plan for copd." if this was an assignment, it's illustrative of why students have such a hard time learning the nursing process-- they pick some sexy-sounding nursing diagnoses and then try to cram the facts into them to make them fit. faculty should make it clear that this is not how the nursing process works, and give the students enough pretend data to work from.

    however, it's possible that i'm wrong, and you already took care of a patient with copd, and now you have to write your care plan. better.

    so. what data do you have, and where does it lead you? what defining characteristics for each nursing diagnosis have you identified in the patient?

    when you go to your nanda-i 2012-2014 (which every student should have), and noodle around in the domains (health promotion, nutrition, elimination and exchange, activity and rest, perception/cognition, self-perception, role, sexuality, coping and stress, life principles, safety, comfort, and growth and development) what do you see that might apply to your patient?

    when you flip open the book to that page, say, comfort, and find "impaired comfort," you will find 18 (in this example) defining characteristics of the nursing diagnosis impaired comfort, and 7 (in this example) factors to which they could be related. if your patient exhibited any of these characteristics, you can diagnose "impaired comfort," and set about determining ways you can make him more comfortable by addressing the defining characteristics that are making him uncomfortable. that is the nursing process-- collect assessment data, determine a diagnosis from them, prescribe nursing remedies, state how you'll measure your remedies' effectiveness, evaluate how they worked, revise as needed.

    we are not (at least some of us are not
    ) going to write your care plan for you. but this is how you should approach it and do it. do not be frightened or freaked out because you can't do it off the top of your head using "common sense," because if common sense were enough we wouldn't need to be teaching you nursing in nursing school. this, the nursing process, is what you are here to learn, because this is what you will be doing when you graduate and go into practice. learn it.

    as a student, i've tried to make a sexy diagnosis. didn't work when my teacher was like, "ohh, really, what's your assessment findings? what's your evidence?" shot down! i chuckled when i read this. i've done this mistake and it's tempting to automatically say impaired gas exchange just because a person has chf. or, situations like this. i see your point.
  8. Visit  KatePasa profile page
    0
    Ineffective Airway Clearance would have priority here.
  9. Visit  GrnTea profile page
    0
    floridatrail, go forth and sin no more.
    katepasa, how do you know that? his airway could be perfectly clear but he could still be in real trouble with copd.
    see? that's why it's, "assessment first, diagnosis second."
  10. Visit  KatePasa profile page
    0
    grntea, i don't know about this student, but there are times that we have to make a care plan before we can assess. the nursing process is fine in theory and should be applied as a rule, however there are instances when you have to care plan for school or clinical before laying hands on the patient.

    planned interventions aren't contractual. if upon assessment, you realize they are inappropriate...rewrite the plan. go with plan b! c! d! if you have a hypothetical patient or one you can't lay hands on yet, you have to plan anyway. assessment can be your first intervention. it's always the first thing on my care plan.

    i firmly believe working up potential priority diagnoses on fictional patients is a fantastic way to learn!

    copd is a disease of airway clearance, due to the reduced capacity of the lungs, destruction of the lungs, and impaired cough...and inability to clear the airway via efficient exhalation. unless you get this patient positioned well, drinking fluids as allowed, having productive coughs and clearing his airway on a good schedule (plus bronchodialators and mucolytics as ordered), unresolved airway issues will stand in the way of gas exchange.

    add pneumonia too the mix and you have nice pools of secretions in the little alveoli, creating yet another airway blockade.
    Last edit by KatePasa on Apr 22, '12 : Reason: edited: forgot something
  11. Visit  KatePasa profile page
    0
    Airway or Gas or what have you are way up the priority totem pole (or down the Maslow's pyramid) from Impaired Comfort. Treat the cause and the discomfort will be resolved in kind.
  12. Visit  FORTHELOVEOF!!!! profile page
    0
    I wish school was like that for us, but we have to formulate our care plan the night before clinicals. When we get there, we have 5 Nursing diagnosis and of them we can change them and rearrange them to fit our patient as far priority. We are taught (in my school) to take the diagnosis and come up 5 nursing diagnosis and do a careplan on 3 of them all the night before we actually meet the patient.
  13. Visit  GrnTea profile page
    0
    i was not recommending impaired comfort as a diagnosis for this patient but as an example of how to use the nanda-i 2012-2014 to determine a diagnosis. i am sorry if i did not make that clear enough.

    i stand by my opinion that you cannot diagnose what you have not assessed, or for which you do not have assessment data. if you want (or your faculty wants) a hypothetical care plan, be sure you are clear on that and can document how it really is/was appropriate.

    of course it's not contractural; it is, however, the nursing process and not just a random exercise in handwriting.
  14. Visit  KatePasa profile page
    0
    That's what the evaluation step of the nursing process is. It is required in a care plan (at least ours, anyway). Even if you have assessed first, you have to document appropriateness via evaluation.

    So, out of curiosity...you wouldn't consider reading patient chart/history/kardex to be a form of assessment?


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